Key result
Square root sign in adult ASD is linked to ~77% of LV filling completing early.
Why the study?
The pathophysiology and hemodynamic characteristics associated with the square root sign in left ventricular diastolic pressure curves in adult ASD patients were not well understood.
Does the square root sign in adult patients with atrial septal defect indicate altered left ventricular diastolic filling dynamics and hemodynamics?
Observational (n=31)
Does the square root sign in adult patients with atrial septal defect indicate altered left ventricular diastolic filling dynamics and hemodynamics?
Answers are grounded in this paper and cite their sources.
The square root sign in adult ASD patients is associated with rapid early diastolic filling and elevated ventricular end-diastolic pressures, suggesting a constrictive pathophysiology.
The square root (dip and plateau) sign was observed in 7 of 21 adult patients with atrial septal defect (ASD). This study evaluated left ventricular (LV) diastolic filling dynamics and hemodynamic findings in 7 patients (Group 1) with, and 14 patients (Group 2) without the square root sign; 10 normal subjects (Group 3) served as controls. No significant differences were observed in LV end-diastolic and end-systolic volumes, ejection fraction, or left to right shunt. In Group 1, 77% of LV filling was completed in the first half of diastole; this percentage was 49% and 53% in Groups 2 and 3, respectively (both p less than 0.01 versus Group 1). Early diastolic filling velocity (at 20% of diastole) in Group 1 was significantly greater, and late diastolic filling velocity (at 80% and 90% of diastole) was reduced in Group 1 compared to those in Groups 2 and 3 (all p less than 0.05). The average values for right and left ventricular end-diastolic pressures were significantly higher in Group 1 (11 +/- 2 and 10 +/- 4 mmHg, p less than 0.05) than Group 2 (7 +/- 2 and 7 +/- 2 mmHg, p less than 0.05). It is suggested that a constrictive pathophysiology due to 4 chambers interaction or right ventricular constraint may play a role in the genesis of the square root sign in ASD.
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Shimizu et al. (1990) conducted an observational in Atrial septal defect (n=31). Square root (dip and plateau) sign vs. Absence of square root sign and normal controls was evaluated on Percentage of left ventricular filling completed in the first half of diastole (p=<0.01). The presence of the square root sign in adult ASD patients was associated with 77% of LV filling completed in the first half of diastole, compared to 49% in those without the sign (p<0.01).
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